Apr 25 Fentanyl Emerges as Newest Threat in Opioid Abuse

Opioid abuse in the United States has skyrocketed in recent years as opiate painkillers have been prescribed more and more [5]. In the early 1990s, prescription opioids such as Oxycontin and MS Contin were most commonly abused. But after a period of time, people began to abuse heroin as they developed a dependence to the prescription drugs. Now, it appears that a similar trend is occurring with heroin and fentanyl; the percentage of opioid death due to heroin in Massachusetts fell from 65% in January 2016 to 50% in September 2016. Over that same time period and region, the percentage of opioid death due to fentanyl rose from 65% to 80% [8]. While this trend has been formally documented in Massachusetts, many other states across the country are experiencing the same crisis; more and more individuals are starting to abuse fentanyl. Some plausible reasons for this shift are that fentanyl is about fifty times more potent than heroin, and that it is much more available on the street since it is completely synthetic [6,1,3]. Curbing this new fentanyl crisis will be a more difficult task than reducing abuse of other opioids because of its increased potency and availability.

Fentanyl is prescribed legally to treat severe pain in patients after major surgery, particularly those who are tolerant to other kinds of opioids [4]. However, the illicit version is of much greater concern to U.S. policymakers and the general public for two primary reasons: it is very difficult to detect when the drug enters the United States, and the synthetic opioid is often laced with other drugs [2]. Since fentanyl is completely synthetic, seasonal limitations do not hinder its production. For example, heroin and morphine are derived from the opium sap of a poppy plant, so their production ebbs and flows with the natural abundance of the plant [5]. Because fentanyl is not derived from a natural source, it can be made in high volumes throughout the year.

Furthermore, the nature of fentanyl’s production and distribution facilitates the drug’s entrance to the United States. Laboratories across China are the main producers of fentanyl, which they ship to Mexico. Drug cartels then mix fentanyl into heroin, or package it to look like anxiety medication [1,2]. These cartels deliver the drug to individual dealers or to the user directly through the Internet with relative ease. In addition to its increased supply, fentanyl is a much more susceptible to addiction and overdose because of its enhanced potency. Fentanyl is often mixed with other opioids (heroin, morphine, etc.) which heightens the effects of the drug, and it inherently elicits a “greater high” due to its chemical structure [2]. The combination of these two factors explains why deaths due to fentanyl overdose rose by 72% from 2014 to 2015 [7].

Policymakers are attempting to reduce the amount of fentanyl on the street by reducing both its supply and demand. The main mechanism through which legislators limit the supply of fentanyl is to control the substance. Controlling a substance involves determining if a certain chemical has the potential to cause dependence and become abused. After making this determination, lawmakers declare the substance to be illegal, or “controlled” [3]. The logic behind creating this legislature is to deter drug suppliers and traffickers from moving their product, out of fear of being prosecuted. However, this technique has proved problematic because producers are able to tweak the molecular structure of the drug to circumvent the newly developed law [1]. The United States Drug Enforcement Association (DEA) is working with the United Nations to identify better ways to get ahead of the production of fentanyl.

Legislators in the Obama administration stressed that reducing the demand of fentanyl was a top priority, arguing that more emphasis needs to be placed on addiction as a disease and that there needs to be “more widespread implementation of well-recognized, evidence-based treatment programs to address the problem” [1]. However, during his campaign, President Trump adopted a different strategy, positing that the primary reason opioid use has spiked in the U.S. has been because of an influx of drugs from Mexico. Consequently, he proposed that building a wall separating the United States and Mexico would disrupt this drug flow and effectively solve the opioid abuse crisis [6]. He has not further elucidated his plans since he has been elected President.

Solving this drug abuse crisis should be of paramount concern to the United States’ government, as drug overdose is quickly becoming one of the leading causes of death in the country. At the forefront of this battle against drugs is fentanyl, the latest opioid to take the lives of thousands of Americans. To this point, policymakers have adopted a reactive policy to fighting the abuse of illicit drugs. In other words, they pass legislation against a particular chemical after it has reached the American public and lead to overdoses. Many have proposed that a promising method to stop illicit drug use is to approach the problem from a public health perspective and educate users about the dangers of prescription drugs. This coincides incredibly well with former President Obama’s approach to tackling drug overdose. However, there is a contingent of individuals who believe that such an approach is too expensive and won’t generate the immediate results that other, more reactionary measures might provide [1]. This debate between large investment for uncertain long-term results and a relatively smaller investment for more immediate results is a nuanced and challenging one, for both sides have valid concerns. It will certainly be interesting to observe which strategy President Trump adopts (or if he adopts a completely different, third strategy) to combat this ever-growing concern among the American population.

"Opioid Overdose." Centers for Disease Control and Prevention. December 16, 2016. Accessed April 11, 2017. https://www.cdc.gov/drugoverdose/data/fentanyl.html.

United States of America. Commonwealth of Massachusetts. Massachusetts Department of Public Health. Data Brief: Opioid-related Overdose Deaths Among Massachusetts Residents. February 2017. Accessed April 11, 2017. http://www.mass.gov/eohhs/docs/dph/stop-addiction/current-statistics/data-brief-overdose-deaths-february-2017.pdf

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